The Desire to be Healed - Therapeutic Landscapes

THE DESIRE TO BE HEALED Modern Healthcare and the need for Therapeutic Gardens By: Andrew Marumoto LARC*3500 Independent Study Martin Holland

Jin Wellbeing County landscape. (Source: Landezine International Landscape Award, 2020: online)

TABLE OF CONTENTS Independent Study Outcomes

1

• Introduction

2

• The Effect of Nature on the Human Mind

2

• The Experience of Placemaking and Control

4

• The Design of Therapeutic Landscapes and the Issue of Pride

5

• Conclusion

8

Personal Reflection

9

References

12

• Annotated Bibliography

13

• Image References

15

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Jin Wellbeing County accessible pathways. (Source: Landezine International Landscape Award, 2020: online)

Independent Study Outcomes

The Desire to be Healed

Introduction What would happen if you were admitted into a healthcare facility indefinitely? Would your waking hours be filled with joy? Would you feel alive as you sit in your hospital bed and gaze out of your window, or would you feel weak and helpless as many do? I am sure many of us would feel discouraged during our stay at a hospital and would often wonder “When am I getting out of here?” When hospitals or healthcare facilities are mentioned, our thoughts can be aligned with sickness, death, or pain. It is not uncommon to visit a hospital that was built during the 19th and 20th centuries and picture a cold, lifeless, institutionalized building that is devoid of greenery around the exterior.

Why is it that we often associate hospitals that were built during this time as unwelcoming institutional places of healing? Before the mid 19th century, healthcare facilities were often designed around nature and treating the mind and body as an interconnected whole. Hospitals were designed and constructed in places with good air circulation; the ancient Greeks and Romans chose sites of sublime natural beauty to build places of healing; and many Christian monks wrote about the importance of gardens for the benefit of one’s mental wellbeing (Marcus, et al., 2013, pp. 6-9; Ward Thompson, 2011, pp. 189-192). What happened during the mid 19th century that prevented us from including the natural environment in our design? Why was there a sudden shift from the biopsychosocial model to the biophysical model?

As medical discoveries were made and the understanding of the human body began to change, so did healthcare facilities. Around the mid 19th century with the discovery of bacteria and the idea of disease spreading through noxious air being refuted; healthcare facilities had a drastic change in the way the human body was treated (Marcus, et al., 2013, p. 9). The treatment of a patient was adopted under the biophysical model where the physical body is treated to bring about healing (ibid). It is true that in-order to heal we need proper rest, medication, and treatment; however, the separation between the mind and body has led to an increase in the cost of treatment due to a decrease in recovery rates. Because of the biophysical approach, healthcare facilities were designed around efficiency and infection control: this often led to hospitals being designed as

Figure 1 - Vancouver General Hospital. (Source: Hanus, n.d.: online)

monoblock buildings that are stark, institutional, and off-putting (see Figure 1) (ibid).

It was not until the late 20th century that we began to see a shift from the biophysical model back to the biopsychosocial model, which brings up the question: “How do we treat the mind and body together to bring about healing through the design of healthcare facilities?” There are multiple ways we can unpack this question and find an answer to, but it is through the use therapeutic and restorative gardens that we begin to see a drastic change in recovery rates, cost, and mental wellbeing when in a healthcare setting.

As described by Clare Cooper Marcus and Naomi A. Sachs, a therapeutic/restorative garden “is one that users, whether residents or patients, experience any way they want: to sit, walk, look, listen, talk, meditate, take a nap, explore. Therapeutic benefits are derived from just being in the garden. No staff is necessary, except for maintenance.” (ibid, p. 3). Together we will explore the effect nature has on the human mind; the experience of placemaking and control; and the design of therapeutic landscapes and the issue of pride.

The Effect of Nature on the Human Mind During the late 20th century, Angelica Thieriot was hospitalized due to a life threatening condition and had a horrible experience at the hospital she was admitted to. Her physical needs were met, and she Page 2

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was given the proper treatment; however, her mental, emotional, and spiritual wellbeing were overlooked and ignored. It was through her experience that she founded Planetree, a non-profit organization that reformed healthcare facilities by designing them through the perspective of a patient. Because of her experience, she was able to bring into question the biophysical model and began to create a new approach as to how we treat the human body (ibid, pp. 10-11).

Around this time, Roger Ulrich, a famous architect and designer came out with his famous 1984 article View through a Window May Influence Recovery from Surgery which changed the way we design hospitals. In his article, Ulrich examined the recovery rate between two different groups of people recovering from gall bladder surgery. Each patient in Group 1 was assigned a room with a window view to a brick wall, while each patient in Group 2 was assigned to a room with a view to a set of trees. It was emphasized that patients in Group 2 made fewer negative comments about mental health and pain; required less pain medication; and were discharged from the hospital within 7.96 days. Group 1 on the other hand, often made negative comments; required more pain medication, and were discharged within 8.70 days (Ulrich, 1984, pp. 420-421). Something as simple as a view that looks out of a window influences recovery time and the need for pain medication.

The Desire to be Healed

17-21). When we think of nature, usually we think of green spaces (spaces dominated by plants and animals) and bluespaces (places dominated by water), but why do we enjoy being in these spaces? Stephen Kellert and Edward Wilson try to explain this affinity for nature in their book The Biophilia Hypothesis. The Biophilia Hypothesis unpacks the understanding of biophilia, which is the love for nature. Kellert and Wilson explain through human evolution, that we have adapted to have a subconscious love for living things such as plants and animals. This states that as humans, we have a human desire to affiliate with nature and life like processes (Kellert & Wilson, 2013, pp. 21, 42). Because of this, the authors state that a separation from human existence and the natural world consequently leads to a “deprived and diminished existence” as stated by Kellert and Wilson; therefore, the opposite is true: when people are connected to nature and have a healthy relationship with the living world, it leads to a fulfilling existence (ibid, pp. 41-42).

Kellert and Wilson reveal to us that we do have a human desire to associate with nature while Craig Chalquist, a philosopher asks the question “Why do we desire to be connected to the symbolism of nature?”

Chalquist is the founder of Terrapsychological Inquiry (TI) which is a philosophical way of thinking regarding the human mind and our connection to nature: this can be seen as an off shoot of ecopsychology or deep ecology.

TI examines the physical, emotional, psychological, In another article by Iyendo, et al. the authors and spiritual health of the human existence in relation noted that unwanted sound (which we will call noise to the health of our surrounding environment; therefore, in this paper) such as the hum of an AC unit, traffic, TI states that if our surrounding environment is healthy, or people yelling often increased levels of stress, we are healthy; if we are healthy, our surrounding depression, and anxiety. On the other hand, it was environment is healthy (Chalquist, 2020, p. 13). emphasized that natural sound often decreased levels of stress, depression, and anxiety by creating a positive While TI dives deeper into the human existence natural distraction: this distraction also led to an and the presence of nature, ecopsychology agrees that increase in motivation and vigour (Iyendo, et al., 2016, humans are a part of nature and holds the core beliefs p. 179). Positive natural distractions can be described that “the flourishing of human and nonhuman life is as environmental features that promote improved of intrinsic value”, and “human health and the health emotional wellbeing, this could be the sound of rushing of nature go together. To be fully well and human, we water, a bird chirping, seeing a tree flutter in the wind, need to live on a healthy world.” (ibid). Ecopsychology etc. (Marcus, et al. 2013, p. 26). emphasizes that the health of our consciousness and the environment depends on if we live in harmony with As mentioned throughout Marcus, et al. book on nature. therapeutic landscapes, physically being in the presence of nature exposes many restorative effects such as stress Picture a landscape with a steady flowing stream, reduction, reduced pain, and a sense of escape (ibid, pp. a nice open grass field, a line of trees that frames the Page 3

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setting sun, and animals of all kinds living in harmony together. What comes to mind when you think of this?

Now think about a derelict parking lot with invasives growing through the cracks; smokestacks billowing a concoction of chemicals in the distance; the noise of traffic from a nearby highway; and a sky shaded out by a veil of smog. Which scene elicits a sense of rest and one that we can find comfort in (See Figure 2a & 2b)?

The Experience of Placemaking and Control Because our surrounding environment influences our health, how does it influence the way we interact with nature? TI further explores the idea that the places we live in influences how we interact with the world and our identity. TI holds the core value that “Our terrain is verifiably and unmistakably real, not a veil of illusion or a purely human construct …

We know reality best by participating in it as fully as possible, individually, and collectively, recognizing our kinship with the other living beings who live here.” (ibid, p. 34). It also holds the view that our geography greatly influences our psyche and what we picture like metaphors, patterns, symbolism, etc. For example, Chalquist states: “Because we are always situated somewhere, we know whatever we know from right here.

Knowledge transported around the world carries the flavour of its origins, places of interpretation, and transit points. We begin emplaced and connected — to nature, place, region, planet — and the quality of our knowing always reflects those connects, just as a branch implies the tree on which it grows.” (ibid, p. 35).

Figure 2a - Peaceful stream with meadow. (Source: American Southwest, n.d.: online)

The Desire to be Healed

In his book on The Experience of Landscape, Jay Appleton shares a quote from a Japanese landscape architect/gardener who goes in depth about the difference between Japanese and Western gardens. The gardener/ architect mentions that the gardens designed in Japan are influenced by Zen Buddhist or Shinto beliefs to meet the surrounding context; that is why we see highly manicured landscapes that appear natural yet reveal the fingerprints left by the human hand. This reveals that the way we design our spaces is influenced by our surrounding context and further grounds our connection to place (Appleton, 1996, p. 201). Why does this matter, what’s so important about our local context? Chalquist argues that the world around us is not just made up of atoms that create unique physical formations, but instead creates an environment where our interactions with nature create “psycho-spiritual” bonds. Chalquist grounds this argument with the example of Mount Fuji.

Mount Fuji is a towering mound of andesite and basalt; however, it is not just the physical properties that make it important. It is a place of cultural significance — a “psycho-spiritual height” if you will — a place where people go to encounter spirits, a place to experience good fortune, a place with spiritual significance, a place that defines Japanese identity (Chalquist, 2020, p. 11).

Along with a sense of place, a sense of control also benefits the psychological health of a person.

When we undergo stress, it is usually induced because there is a lack of control in whatever circumstance we are in: deadlines begin to pile up as we drown in work; a relationship ends that was not expected; we are asked to do more than we can provide, etc. the amount of stressors are endless; however, by giving people a sense of control through placemaking, it allows people to reduce stress by changing their surrounding

Figure 2b - Derelict garage overlooking bay. (Source: Lyons, n.d.: online) Page 4

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The Desire to be Healed

environment to tailor it to their own needs (Marcus, et al. 2013, pp. 24-25). By creating spaces that ground a sense of place and give control to a user creates a temporary escape from the stressors of life. When in these spaces, it allows the user to look inwards reflect on themselves, find their identity, and creates a space where one does not need to worry about reality.

When we find that we are stressed, what do we do? Some may go on their phones and watch a TV show to escape reality; others go outside to feel that they are part of something bigger than themselves; others may cope with substances or a vice to create an escape. No matter what our methods are, it reveals the deep human need for a sense of control in one’s life and a place we can go to find a sense of control and identity. By needing these spaces, it reveals that designers need to consider how we create a sense of place and control within our designs. On the other hand, it also shows us that bad design can lead to a lack of control which further increases stress levels (Ulrich, 1992, p. 23).

In a series of interviews conducted by Anna Adevi, Mats Lieberg, and Fredrika Mårtensson, the authors interview caregivers and patients at the Alnarp Rehabilitation Clinic in Sweden. The clinic is known for helping individuals manage with stress by using a therapeutic garden and garden therapy. The activities they conduct there are sensory impressions, self-chosen places, and activities that are concrete and symbolic; for the sake of this paper, we will focus on sensory impressions and self-chosen places.

Sensory impressions can be described to “seek and find a sense of belonging in nature’s order, which allows them to feel they are part of something much greater than the immediate environment.” (Adevi & Lieberg, 2012, p. 54). Sensory impressions are passive ways a patient interacts with their surrounding environment to receive enabling effects from the therapeutic garden. Simply, a patient can be present in a therapeutic garden after a session with a caregiver and let the garden “speak” to them to provide a sense of peace. Self-chosen places correlates directly with sensory impressions since patients are allowed to wander the garden to freely find a place, they find comfort in. By allowing patients to choose their own location, it allows them to find a sense of identity, ownership, and control which can relate to their current

Figure 3 - A forest trail for contemplative walks. (Source: pxhere, n.d.: online)

emotions: this in turn, reduces stress. For example, one of the patients in the interviews conducted by Adevi and Mårtensson, a patient states “All the different rooms and parts of the garden that could fit the mood I was in at that moment. So, a garden does not ask for something back. I could talk, say what the hell I wanted to the pine trees there, and they didn’t shout back at me.” (Adevi & Mårtensson, 2013, p. 233). By being able to escape to a place that corelates to our emotions, it makes them real and allows us to cope with them in a way that is restorative; it allows us to be truly honest with ourselves and not feel judged by our immediate surroundings (see Figure 3). As Craig Chalquist states: “As for place: no, we have always gravitated intuitively towards locations that symbolize what we seek, whether mountaintops for peak experiences and higher views, deserts for clear skies and contemplative austerity, valleys for settling down and soul-searching … It is not that the features of such places cause our states of mind. The simple logic of cause and effect cannot serve the complexity of the relationship — or its nonduality, for geology, geography, and materiality are forms of psychology. Where is where we begin.” (Chalquist, 2020, p. 11).

The Design of Therapeutic Landscapes and the Issue of Pride Why do we need therapeutic landscapes in healthcare spaces? As we have explored, the presence of nature, and a grounded sense of place reduces our Page 5

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The Desire to be Healed

levels of stress and subconsciously reduces pain. It is undeniable that a healthcare setting for patients and caretakers is a stressful environment. As Marcus, et al. explore therapeutic landscapes and healthcare settings, they state that therapeutic gardens/landscapes must be incorporated into these spaces as the presence of nature reduces stress (see Figure 4). They also state that many people who are undergoing stress seek out spaces dominated by nature to cope, even if they do not know the facts behind reducing stress (Marcus, et al., 2013, p.

24).

If the spaces we inhabit, and the landscapes near healthcare facilities appear natural, would they be therapeutic? Yes and no. The presence of nature alone and the aesthetic appeal do not make a landscape therapeutic. For a landscape to be considered therapeutic, it must match the definition provided by Marcus and Sachs and should follow either the Stress Reduction Theory (SRT) model provided by Roger Ulrich, or the Attention Restoration Theory (ART) model provided

by Rachel Kaplan and Stephen Kaplan. Aside from the models of stress reduction, it is also encouraged that therapeutic landscapes follow the 7:3 ratio where 70% of the site is vegetation and the other 30% is hardscape (ibid, p. 27-28).

SRT states that these four factors must be met for a landscape to be considered therapeutic: provides a sense of control, social support, physical movement, and positive natural distractions. A sense of control can be encouraged by moveable furniture; giving options for seating to enjoy a landscape feature; adequate signage to be directed to a garden, etc. Social support grounds users into a community which provides comfort and control: this can be encouraged by providing communal spaces. Physical movement improves physical and emotional wellbeing which in-turn reduces stress.

Physical movement can be encouraged by giving people an incentive to move, even something as simple as a pond or a gazebo encourages someone to explore by adding visual interest. Finally positive natural distractions improve mental wellbeing as explored earlier in this paper (ibid, pp. 24-28; & Ulrich, 1992, pp. 23-25).

Figure 4 - A rooftop therapeutic garden with multiple amenities.

(Source: Live Green Landscape Associates, n.d.: online)

meet these four conditions to create a true escape from stress, they are: being away, extent, fascination, and compatibility. Being away is the aspect given to a site where a user can withdraw from the source of stress; however, that alone is not enough and must provide an extent of escape (Marcus, et al. 2013, p. 28). Extent is the value given to being away: if someone is in a site with low extent, they may feel that they are barely escaping their source of stress. A site with high extent allows a user to feel they are in a new environment that allows for exploration. A site that has high extent can either be manifested physically or mentally and should provide a high level of fascination (ibid, pp.

28-29). Fascination is the attribute given to a site or a landscape element that holds a user’s attention and causes them to think about something else (ibid, p. 29).

Finally, Compatibility is the quality given to a site that that provides adequate spaces to a users needs. For example, if someone wishes to be alone, the site should provide spaces of refuge (ibid).

Design considerations for ART include coherence, complexity, legibility, and mystery (ibid).

Coherence defines that a site must be organized into spaces that are coherent and have smooth transitions; there must also be adequate signage/design considerations for a site to be easily legible. If a site is disjointed and lacks adequate signage for navigating, it could act to the detriment of a user’s health by making the experience stressful and frustrating; thus, leaving them worse than they were before. If a site lacks The Kaplan’s ART model is designed around complexity, it could appear monotonous and would disconnecting people from sources of stress to reduce lack visual interest to provide the sense of escape that stress and mental fatigue. ART states that a site must one seeks in a therapeutic landscape. Legibility is the Page 6

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ability of a site to provide elements that are memorable and give it a unique identity. For example, the highline in New York remains iconic today due to it being greenspace form a repurposed railway. On the other hand, your neighbour’s backyard may not be legible because it looks no different than every other backyard you have been in. If a space lacks legibility, it prevents us from truly escaping our stressors because we feel that we are in a space that fails to grapple our attention.

Mystery is attributed to a site that creates a sense of tension in a user by drawing them in to explore the site in its entirety rather than remain in one space (ibid).

While SRT begins to understand how we provide elements to a user to reduce their stress, ART goes a step further and provides design considerations that go deeper than simply designing a space that encourages movement and social support. ART is argued to be the greater design theory in all aspects of space design, especially those in healthcare settings (ibid). It is a design theory that not only needs to be applied to patients in need of stress recovery, but also expands its demographic to all users, whether that be healthcare staff, families visiting, or even someone exploring local landscapes. ART passively encourages stress recovery by providing positive natural and built distractions that occupy the thoughts that plague our psyche (ibid).

The Desire to be Healed

reducing medical costs by preventing the amount of pain medication a patient needs and by assisting them on their path to recovery (Ulrich, 1984, pp. 420-421).

These spaces can also prevent workplace accidents and human error by providing staff a place to escape to and recover from stress. It is common knowledge that stress is a leading cause to making mistakes since it increases our blood pressure, muscle tension, and causes headaches. By preventing workplace accidents (e.g. a botched surgery, a patient given the wrong medication, etc.), therapeutic landscapes can indirectly lead to a reduction in lawsuits and the intervention needed to remedy the effects of workplace accidents.

Aside from SRT and ART, the Emotional Congruence Theory (ECT) MUST be considered by all designers, especially those new to the design of therapeutic spaces. ECT states that people who are happy tend to be more optimistic while people who are stressed or depressed may interpret something differently and see it in a negative light (Marcus, et al., 2013, p. 30). For example, Roger Ulrich and Outi Lunden conducted a study in Sweden that looked at artwork placed on the walls in healthcare facilities. In one facility, there was a wall that contained a variety of photos: some displaying natural landscapes, cities, and abstract art. It was observed that patients gravitated towards photos of natural landscapes and made positive comments on them. It was also observed that the abstract photos were associated with negative comments to the point when one patient physically attacked a group of seven abstract paintings (Ulrich, 1992, p. 25).

Even though therapeutic gardens can be expensive in the initial upfront cost, ultimately it will lead to a cost benefit that further outweighs the cons and ends up saving money. If designed properly, garden/landscape spaces in healthcare facilities can reduce the cost of energy and heating if strategically ECT reveals to us that it is essential that designed. Therapeutic landscapes can also be used in therapeutic gardens should be approached as spaces geared towards healing, rather than spaces of aesthetic interest. Therapeutic spaces should have aesthetic appeal; however, that must not be the focus. If a landscape architect were to design a therapeutic garden that is aesthetically pleasing but does little to provide spaces to escape to or reduce stress, could it be labelled as good design? The short answer: NO. If a therapeutic space is visually pleasing but does not provide a sense of rest, then it cannot be considered therapeutic, but instead, could lead to the detriment of one’s psychological health: especially if there is abstract imagery/form across the site (see Figure 5). As Figure 5 - Fukuoka Sanno Hospital landscape with inaccessible ECT shows us, if a patient is already in a fragile state, furniture and abstract forms. (Source: Architizer, n.d.: online)

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The Desire to be Healed

understand the effect nature has on the human mind; the importance of place making and control; and the models of design for therapeutic spaces. If a designer approaches a therapeutic landscape like any other site design or as a portfolio project, it could lead to the As a designer, it is essential that we leave our ego detriment of one’s health. at the door when designing these spaces. Therapeutic What would the world look like if every gardens are not meant to be treated as another project for the portfolio. The essence of a designer for a outdoor space was designed to be therapeutic in nature? therapeutic garden is to create a space that one finds That is something that I believe every designer should rest in no matter what situation they are going through. explore when designing spaces. Not everything needs What makes therapeutic landscape design challenging to be therapeutic and follow a one-size fits all model; is that it is a relatively new field and lacks proper however, if every space was approached in this way, design guidelines in healthcare design guideline books. especially in an urban setting, I believe that we would In the 2014 Guidelines for Design and Construction see an improvement in levels of stress or at least an of Hospitals and Outpatient Facilities, there are only improvement in coping with stress. As designers, how two guidelines for the construction of water features can we approach therapeutic landscape design not only and outdoor facilities. Guideline 1.3-3.5.1 states that in healthcare settings, but every setting? outdoor water features should remain sanitized to I would have loved to cover the effects of blue prevent the spread of disease (Guidelines for Design and spaces on the human mind and alternative natural Construction of Hospitals and Outpatient Facilities, 2014, p. 48). Guideline 1.3-3.5.2 encourages the use of spaces such as deserts, glaciers, and caves (Li, et al., outdoor facilities such as therapeutic gardens and states 2023); however, I was not able to include those topics that they be incorporated depending on site constraints. due to page and word constraints. The one note I would The guideline also encourages the use of local/native like to add is that the presence of water does provide materials for a reduced cost; encourages movement therapeutic effects to the human mind (Smith, et al. for all users; and encourages the use of landscape for 2022, p. 7), but the presence of water alone does not therapeutic effects; however, the guideline provides benefit stress recovery; instead, it is the qualities of water no information as to how a garden can be therapeutic (wateriness) in relation to the surrounding environment or the accessibility measures that need to be taken for (Pitt, 2018, p. 169). You can find more information on all users of the site (ibid). Even though there is a lack these topics in the Annotated Bibliography. of information in the official design guidelines for healthcare facilities, there are books such as Marberry, et al., 1997, Healthcare Design and Marcus, et al., 2013, Therapeutic Landscapes which provides important design considerations for therapeutic landscapes. whether that be mentally or physically, abstract art can foster/heighten those negative emotions which further increases stress (ibid; & Marcus, et al., 2013, pp. 3031).

Conclusion As we have explored, therapeutic landscapes not only provide visual appeal to healthcare facility landscapes; instead, they provide an escape from sources of stress while also influencing how we cope with pain. As designers, we must approach the design process of these spaces with the human experience in mind and how to provide a sense of rest, ownership, and peace to site users. Designers must be able to Page 8

PERSONAL REFLECTION

Jin Wellbeing County edible garden. (Source: Landezine International Landscape Award, 2020: online)

Personal Reflection

Personal Reflection For the most part, I really enjoyed learning about therapeutic gardens this semester. The topics that I found to be the most interesting were the effect of nature on the human mind; how water quality can lead to enabling and disabling effects with stress; and the experience of placemaking/identity building. The most useful/interesting books and articles I found were Terrapsychological Inquiry by Craig Chalquist, Therapeutic Landscapes by Clare Cooper Marcus, et al., How Design Impacts Wellness by Roger Ulrich, Beyond “bluespace” and “greenspace” by Hansen Li, et al., and Muddying the waters by Hannah Pitt. I really enjoyed these pieces of literature since they went outside of the box and pushed the boundaries as to what could be considered therapeutic. I especially found Chalquist’s book, Marcus, et al. book, and Pitt’s article to be the most influential and something that I could see myself applying to my future career.

The Desire to be Healed

however, therapeutic gardens are not your conventional landscape because a designer has to design it for the sole purpose of restoring stress levels and to create an escape from the hustle and bustle of the world. They are not sites that are just meant to be aesthetically pleasing (they should be pleasing to look at), they need to be sites focused on the user of the site (nurses, patients, etc.) and should not be used solely as a portfolio project.

I was going to include a section on a particular site design, but I did not have enough space to discuss it. I really wanted to mention the Fukuoka Sanno Hospital landscape and the failure it is as a healthcare landscape. I have included a photo in Figure 5 of the landscape, but there is more to it than just the one photo. It is an aesthetically pleasing design, but it is almost like its meant to taunt patients in a hospital. It is completely inaccessible for people with mobility issues, it is dominated by hardscape, and is extremely abstract. It looks cool to visit, but in no way seems therapeutic. I would highly recommend looking at some I am glad that I spent this semester learning of the landscape photos on Architizer an architecture those topics; however, there were some topics that did website (https://architizer.com/projects/the-landscapenot pique my interest, and others that I could not see architecture-of-fukuoka-sanno-hospital/). myself using in the future. For example, Jay Appleton’s Through this study, I have learned about my Experience of Landscape was interesting to look at, but it was inaccessible for me to read as a designer: some aesthetic tastes and how I want to approach design. words were really lofty and went through one ear and I want to apply what I have learned about nature and out the other. I think if I was an artist who was interested the effect it has on the human mind to create spaces in abstract art or anything involving landscape it would that cause people to feel greater emotion or to sit and have been interesting. There were some other articles ponder about things. I often find that when I want to that were dry but needed to be read to back-up my sit and think, I either go on a walk somewhere, or sit somewhere and focus my eyes on something like a points or to gain some extra background information. sculpture or cool building. I want to create spaces that There was a lot of information that I picked up people can escape to and ponder their own thoughts or through this project, and there is a fair amount I can see to think deeper about the meaning of life if that makes myself applying to future practice; however, I think I sense. I don’t know what it is, but I really want to use discovered that therapeutic gardens are not something concrete as a medium or materials that look industrial I want to specialize in. They are super interesting, but in nature, yet are tame and harmonize well with nature.

I don’t think it is the right fit for me. I would love to I want to create a blend between the man made and the do some work with therapeutic gardens and to design natural, similar to what MVVA practices. spaces that give people joy and rest, but I also really I really enjoyed researching and learning about want to get into making more abstract designs similar to the work of Lawrence Halprin, SHMA Company therapeutic designs; however, I think I am at a place Limited, or Michael Van Valkenburgh and Associates where I can start applying what I have learned to (MVVA). If this project has taught me anything, it future designs. I want to get more into paper landscape is that landscape architects CAN NOT approach a architecture and have fun experimenting with therapeutic garden like any other typical design. Yes, 3D-modelling programs and the built form to influence each site is different and has its own context/identity; how people feel. I don’t know how I’ll get there, but I Page 10

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am really looking forward to exploring these interests.

Thank you Martin, for taking me under your wing this semester and for giving me the opportunity to dive depper into my passion of landscape architecture. I wish you the best and I really do hope you have an awesome/ restful summer. Thank you for making these last two semesters memorable and teaching us the breadth of landscape architecture with passion!

- Andrew Marumoto

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REFERENCES

Jin Wellbeing County reflexology path. (Source: Landezine International Landscape Award, 2020: online)

References

Annotated Bibliography

The Desire to be Healed

to therapeutic gardens and was hard to understand.

Adevi, A. A., & Lieberg, M. (2012). Stress rehabilitation Chalquist, C. (2020). Terrapsychological inquiry: restorying our relationship with nature, place, and through garden therapy A caregiver perspective on planet. Routledge. factors considered most essential to the recovery In Chalquist’s Terrapsychological Inquiry (TI), process. Urban Forestry & Urban Greening, 11(1), Chalquist goes in depth to hypothesize a new 51–58. https://doi.org/10.1016/j.ufug.2011.09.007 form of psychology similar to deep ecology by Adevi and Lieberg interview caregivers at the Alnarp examining the human body and how it is physically, Rehabilitation Centre in Sweden and ask how a mentally, emotionally, and spiritually influenced by therapeutic garden and garden therapy aids people the presence of nature. TI questions how we in the at combating stress. It was highlighted that there are West perceive the world and brings to light a new three main aspects of garden therapy and therapeutic way of thinking by viewing our bodies and minds gardens. They include sensory impressions, selfas one with the earth. Chalquist’s TI reveals that the chosen places, and interactions between concrete health of the environment around us correlates to and symbolic activities. Emphasized throughout our own mental, physical, emotional, and spiritual the article was the idea that a sense of place and health; therefore, Chalquist emphasizes that for us ownership greatly influences stress recovery. (humans) to be healthy, our environments need to Adevi, A. A., & Mårtensson, F. (2013). Stress be thriving rather than subdued by development rehabilitation through garden therapy: The garden such as urban sprawl. as a place in the recovery from stress. Urban Forestry & Urban Greening, 12(2), 230–237. https://doi. Guidelines for design and construction of hospitals and outpatient facilities (2014 edition.). (2014). org/10.1016/j.ufug.2013.01.007 American Society for Healthcare Engineering.

In this article, Adevi and Mårtensson interview five The contents of this book go over the general previous participants at the Alnarp rehabilitation guidelines for the construction and design of clinic and are asked the following questions hospital and outpatient facilities. The book goes in regarding garden therapy: “what do participants depth regarding the interior of a hospital and the experience as active dimensions in their recovery?”, precautions to be taken to ensure patient safety.

How do participants describe the role of the garden For the sake of this paper, there is very minimal to their path of recovery? And do theories regarding information on therapeutic gardens and the use of restoration and place attachment relate to parameters landscape as healing. In this book they encourage of the recovery process? This article looks at certain the use of therapeutic gardens; however, it provides place attachment theories and how they relate to the little detail as to how gardens should be designed. recovery process.

Appleton, J. (1996). The experience of landscape (Rev. Iyendo, T. O., Uwajeh, P. C., & Ikenna, E. S. (2016).

The therapeutic impacts of environmental design ed.). Wiley. interventions on wellness in clinical settings: In his book on art and landscape, Appleton goes in A narrative review. Complementary Therapies depth emphasizing the origins of taste in landscape in Clinical Practice, 24, 174–188. https://doi. aesthetics. Appleton looks at historical texts org/10.1016/j.ctcp.2016.06.008 created by philosophical figures, famous artists, In Iyendo et al. article, the authors conduct a narrative and landscape enthusiasts throughout history. The review of design considerations for a well designed main topics discussed are the origins of taste which healthcare facility. The authors emphasize that art was highlighted by ancient Greek and Roman therapy, the auditory environment, architecture, philosophers. Appleton then goes in depth about therapeutic gardens, musical therapy, lighting, the argument between sublime and picturesque etc. are aspects that need to be considered when landscapes, and how the argument has influenced designing a healthcare facility. This is important modern thought. For the purpose of this paper, it since these factors can bring about enabling effects was hard to find useful information that pertained Page 13

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which reduce stress which induces an improved recovery rate compared to poorly designed sites.

Kellert, S. R., & Wilson, E. O. (2013). Biophilia Hypothesis. Island Press.

In their book, Kellert and Wilson propose a hypothesis known as Biophilia which is the human need/desire to affiliate with nature and a lifelike process that promotes life. The authors expand the hypothesis by examining human evolution, the way we interact with nature, and how the consequences influence our mind. This book has been influential to promote restorative design with therapeutic gardens as it reveals that there is a human need to associate with nature.

The Desire to be Healed

healthcare design goes in depth about elements in a healthcare facility such as design, products, and human needs. The design section discusses the design process for healthcare design and how to stretch the limits of building codes for better design without breaking the code; products emphasize the built environment of the hospital such as lighting, ceilings, floors, etc. and what materials should be used for healthcare design; human needs emphasize what patients need in a healthcare facility and how a designer can provide for those needs. It is in the human needs section that the authors discuss therapeutic gardens and the effects of landscape architecture on the human mind.

Marcus, C. C., Sachs, N. A., Hazen, T., & Barnes, M. Li, H., Browning, M. H. E. M., Rigolon, A., Larson, (2013). Therapeutic Landscapes: An EvidenceL. R., Taff, D., Labib, S. M., Benfield, J., Yuan, Based Approach to Designing Healing Gardens S., McAnirlin, O., Hatami, N., & Kahn, P. H. and Restorative Outdoor Spaces (1st ed.). John (2023). Beyond “bluespace” and “greenspace”: Wiley & Sons, Inc. A narrative review of possible health benefits from Marcus, et al. book does an examination of exposure to other natural landscapes. The Science therapeutic gardens, and how landscape could be of the Total Environment, 856, 159292–159292. used in healthcare facilities to bring about relief https://doi.org/10.1016/j.scitotenv.2022.159292 from stress to promote healing. The book is intended Li et al. article asks the question if natural spaces to be used by clients, designers, and stakeholders of devoid of liquid state water and biomass can be healthcare facilities to design outdoor spaces that therapeutic. The authors do a literature review to bring about healing. Marcus, et al. emphasize this answer their hypothesis by examining articles and by revealing best practices for creating therapeutic books regarding natural spaces dominated by sand/ landscapes and how Evidence Based Design (EBD) arid climates, snow/ice, and caves. It was noted in and stress restoration theories can be used to assist their review that a portion of these spaces provide in landscape design. Marcus, et al. also look at how short term therapeutic benefits, and a majority of therapeutic gardens have historically been used to them provide long term benefits (living in that type bring about healing in people from the time of the of space for over three months); however, the long Romans to the present. term benefits come from the challenges of living in those spaces and dealing with harsh weather Pitt, H. (2018). Muddying the waters: What urban conditions; therefore, the authors conclude that waterways reveal about bluespaces and wellbeing. more research needs to be done on these spaces to Geoforum, 92, 161–170. https://doi.org/10.1016/j. prove whether there are passive therapeutic effects geoforum.2018.04.014 from these spaces.

Pitt hypothesizes in her article that not all bluespaces are restorative and proves her hypothesis Marberry, S. O., Zimring, C., Nepp, B., Hillman, R., be interviewing random people around urban Cama, R., Geddis, B. L., Trimmer, K., Perkins, B., waterways. Pitt emphasizes that there are therapeutic McCuskey Shepley, M., Mathis, J. F., Duffy, T., effects from blue spaces; however, it depends on Radke, R., Horton, J. G., Gurian, M., Rodemann, P. the wateriness (qualities such as reflectance, colour, A., Ruga, W., Zagon, L., Fuston, A., Plaskon Nadel, turbidity, etc.) of the water. Pitt’s article reveals K., Burnett, J. D., Carpman, J. R., & Grant, M. that bluespaces can also be disabling to mental (1997). Healthcare design. Wiley. wellbeing depending on how they are maintained.

Marberry, et al.’s book on general best practices for Page 14

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The Desire to be Healed

Smith, N., Foley, R., Georgiou, M., Tieges, Z., Journal of Environmental Psychology 11, 201–230. & Chastin, S. (2022). Urban Blue Spaces as Ulrich, et al. examine models of stress recovery by Therapeutic Landscapes: “A Slice of Nature in interviewing 120 participants and conducting tests the City.” International Journal of Environmental on them. The participants viewed a stressful video Research and Public Health, 19(22), 15018–. and then were shown a video of either a natural or https://doi.org/10.3390/ijerph192215018 an urban environment. Stress levels were recorded Smith et al. interview random passersby at the through bodily measurements like blood pressure Glasgow Canals to inquire of their thoughts regarding to observe how participants recovered from stress blue spaces and whether they are therapeutic or not. and were then compared to proposed models of This article goes in depth about proving that blue stress recovery. It was observed that the videos spaces are restorative; however, the article is biased dominated by natural environments greatly reduced since participants were only interviewed around stress levels compared to the videos of urban bluespaces. If someone is opposed to blue spaces environments. or is frightened by them, they would not be around bluespaces; therefore, the article has a bias in only Ward Thompson, C. (2011). Linking landscape and health: The recurring theme. Landscape and Urban showing the positive aspects of blue spaces rather Planning, 99(3), 187–195. https://doi.org/10.1016/j. than the negative aspects that are associated with landurbplan.2010.10.006 them, such as deep water, sanitation, etc.

In her article, Ward Thompson examines how Ulrich, R. (1984). View through a Window May Influence landscapes were designed to bring about therapeutic Recovery from Surgery. Science (American effects throughout history. The author begins from Association for the Advancement of Science), the time of the ancient Romans up until the present 224(4647), 420–421. https://doi.org/10.1126/ and emphasizes the shift in the treatment of the science.6143402 human body to bring about healing in a patient.

Ulrich’s article emphasizes that a view through a window to a natural landscape compared to an urban landscape brings about enabling effects in Image References stress recovery after an operation in a healthcare facility. Ulrich’s article is highly influential and American Southwest. (n.d.). Shallow stream through Paradise Meadows - upper end of a tributary of Hat was an initial catalyst in changing the healthcare Creek. [Online image] [Accessed on 9th April 2023] environment from a biophysical model to a https://www.americansouthwest.net/california/ biopsychosocial model. lassen_volcanic/paradise-stream2_l.html Ulrich, R. S. (1992). How Design Impacts Wellness. Architizer. (n.d.). [Image of Fukuoka Sanno Hospital Health Forum Journal, 35(5), 20–25.

Landscape]. [Online image] [Accessed on 9th April In his article, Ulrich examines how good and bad 2023] https://architizer.com/projects/the-landscapedesign effect a patient in a healthcare facility after architecture-of-fukuoka-sanno-hospital/ an operation. Ulrich emphasizes that bad design can lead to disabling effects in a patient that does Hanus, J. (n.d.). Vancouver General Hospital’s Jim Pattison Pavillion. [Online image] [Accessed not promote stress recovery, while good design on 9th April 2023] https://dailyhive.com/ highlights enabling effects which accelerates the vancouver/vancouver-general-hospital-expansionrate of recovery. It is also noted that bad design february-2017 also leads to greater expenses due to the need of medication, labour, and operating costs induced Landezine International Landscape Award. (2020). from a reduced rate of recovery.

Aerial View of Jin Wellbeing County, showing Ravine Forest. [Online image] [Accessed on 10th Ulrich, R.S., Simons, R.F., Losito, B.D., Fiorito, E., April 2023] https://landezine.com/jin-wellbeingMiles, M.A., & Zelson, M. (1991). Stress recovery county/ during exposure to natural and urban environments.

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Landezine International Landscape Award. (2020).

Commuting through the lush path. [Online image] [Accessed on 10th April 2023] https://landezine. com/jin-wellbeing-county/ Landezine International Landscape Award. (2020).

Edible Garden Area. [Online image] [Accessed on 10th April 2023] https://landezine.com/jinwellbeing-county/ Landezine International Landscape Award. (2020).

Therapeutic Garden with reflexology path and resting. [Online image] [Accessed on 10th April 2023] https://landezine.com/jin-wellbeing-county/ Live Green Landscape Associates. (n.d.). Larynth From Above. [Online image] [Accessed on 9th April 2023] https://www.livegreenlandscapes.com/project/ rooftop-healing-garden/ Lyons, B. (n.d.). Derelict vehicles, garbage litter city property on Front Street. [Online image] [Accessed on 9th April 2023] https://www.silive.com/galleries/ OQJ6Q2IAO5GMZKWDY25SMENOI4/ pxhere. (n.d.). [Image of a meandering forest walkway.

[Online image] [Accessed on 9th April 2023] https:// pxhere.com/en/photo/602579

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